scholarly journals Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation

2008 ◽  
Vol 101 (7) ◽  
pp. 1079-1087 ◽  
Author(s):  
Christophe Faisy ◽  
Nicolas Lerolle ◽  
Fahmi Dachraoui ◽  
Jean-François Savard ◽  
Imad Abboud ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Energy Balance ◽  
Characteristic Curve ◽  
Resting Energy Expenditure ◽  
Negative Energy ◽  
Energy Deficit ◽  
Medical Patients ◽  
Icu Mortality ◽  
Exclusive Enteral Nutrition ◽  
Predictive Method

To assess energy balance in very sick medical patients requiring prolonged acute mechanical ventilation and its possible impact on outcome, we conducted an observational study of the first 14 d of intensive care unit (ICU) stay in thirty-eight consecutive adult patients intubated at least 7 d. Exclusive enteral nutrition (EN) was started within 24 h of ICU admission and progressively increased, in absence of gastrointestinal intolerance, to the recommended energy of 125·5 kJ/kg per d. Calculated energy balance was defined as energy delivered − resting energy expenditure estimated by a predictive method based on static and dynamic biometric parameters. Mean energy balance was − 5439 (sem222) kJ per d. EN was interrupted 23 % of the time and situations limiting feeding administration reached 64 % of survey time. ICU mortality was 72 %. Non-survivors had higher mean energy deficit than ICU survivors (P = 0·004). Multivariate analysis identified mean energy deficit as independently associated with ICU death (P = 0·02). Higher ICU mortality was observed with higher energy deficit (P = 0·003 comparing quartiles). Using receiver operating characteristic curve analysis, the best deficit threshold for predicting ICU mortality was 5021 kJ per d. Kaplan–Meier analysis showed that patients with mean energy deficit ≧5021 kJ per d had a higher ICU mortality rate than patients with lower mean energy deficit after the 14th ICU day (P = 0·01). The study suggests that large negative energy balance seems to be an independent determinant of ICU mortality in a very sick medical population requiring prolonged acute mechanical ventilation, especially when energy deficit exceeds 5021 kJ per d.

scholarly journals Lipoprotein Subclass Profile after Progressive Energy Deficits Induced by Calorie Restriction or Exercise

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1814 ◽  
Author(s):  
Yu Chooi ◽  
Cherlyn Ding ◽  
Zhiling Chan ◽  
Jezebel Lo ◽  
John Choo ◽  
...  
Keyword(s):  
Energy Balance ◽  
Aerobic Exercise ◽  
Calorie Restriction ◽  
Plasma Concentrations ◽  
Negative Energy ◽  
Negative Energy Balance ◽  
Energy Deficit ◽  
Dependent Manner ◽  
Blood Lipid Profile ◽  
Diet And Exercise

Weight loss, induced by chronic energy deficit, improves the blood lipid profile. However, the effects of an acute negative energy balance and the comparative efficacy of diet and exercise are not well-established. We determined the effects of progressive, acute energy deficits (20% or 40% of daily energy requirements) induced by a single day of calorie restriction (n = 19) or aerobic exercise (n = 13) in healthy subjects (age: 26 ± 9 years; body mass index (BMI): 21.8 ± 2.9 kg/m2). Fasting plasma concentrations of very low-, intermediate-, low-, and high-density lipoprotein (VLDL, LDL, IDL, and HDL, respectively) particles and their subclasses were determined using nuclear magnetic resonance. Total plasma triglyceride and VLDL-triglyceride concentrations decreased after calorie restriction and exercise (all p ≤ 0.025); the pattern of change was linear with an increasing energy deficit (all p < 0.03), with no evidence of plateauing. The number of circulating large and medium VLDL particles decreased after diet and exercise (all p < 0.015), with no change in small VLDL particles. The concentrations of IDL, LDL, and HDL particles, their relative distributions, and the particle sizes were not altered. Our data indicate that an acute negative energy balance induced by calorie restriction and aerobic exercise reduces triglyceride concentrations in a dose-dependent manner, by decreasing circulating large and medium VLDL particles.

scholarly journals Nutrition in Ultra-Endurance: State of the Art

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1995 ◽  
Author(s):  
Pantelis Nikolaidis ◽  
Eleftherios Veniamakis ◽  
Thomas Rosemann ◽  
Beat Knechtle
Keyword(s):  
Energy Balance ◽  
Negative Energy ◽  
Energy Deficit ◽  
Endurance Sports ◽  
Increased Risk ◽  
Gastrointestinal Discomfort ◽  
And Performance ◽  
Hot Environments ◽  
Ultra Endurance ◽  
Nutritional Strategies

Athletes competing in ultra-endurance sports should manage nutritional issues, especially with regards to energy and fluid balance. An ultra-endurance race, considered a duration of at least 6 h, might induce the energy balance (i.e., energy deficit) in levels that could reach up to ~7000 kcal per day. Such a negative energy balance is a major health and performance concern as it leads to a decrease of both fat and skeletal muscle mass in events such as 24-h swimming, 6-day cycling or 17-day running. Sport anemia caused by heavy exercise and gastrointestinal discomfort, under hot or cold environmental conditions also needs to be considered as a major factor for health and performance in ultra-endurance sports. In addition, fluid losses from sweat can reach up to 2 L/h due to increased metabolic work during prolonged exercise and exercise under hot environments that might result in hypohydration. Athletes are at an increased risk for exercise-associated hyponatremia (EAH) and limb swelling when intake of fluids is greater than the volume lost. Optimal pre-race nutritional strategies should aim to increase fat utilization during exercise, and the consumption of fat-rich foods may be considered during the race, as well as carbohydrates, electrolytes, and fluid. Moreover, to reduce the risk of EAH, fluid intake should include sodium in the amounts of 10–25 mmol to reduce the risk of EAH and should be limited to 300–600 mL per hour of the race.

scholarly journals Metabolic adaptations during negative energy balance and their potential impact on appetite and food intake

2019 ◽  
Vol 78 (3) ◽  
pp. 279-289 ◽  
Author(s):  
Nuno Casanova ◽  
Kristine Beaulieu ◽  
Graham Finlayson ◽  
Mark Hopkins
Keyword(s):  
Weight Loss ◽  
Energy Balance ◽  
Food Intake ◽  
Negative Energy ◽  
Fat Free Mass ◽  
Negative Energy Balance ◽  
Energy Deficit ◽  
Behavioural Responses ◽  
Compensatory Responses ◽  
Metabolic Adaptations

This review examines the metabolic adaptations that occur in response to negative energy balance and their potential putative or functional impact on appetite and food intake. Sustained negative energy balance will result in weight loss, with body composition changes similar for different dietary interventions if total energy and protein intake are equated. During periods of underfeeding, compensatory metabolic and behavioural responses occur that attenuate the prescribed energy deficit. While losses of metabolically active tissue during energy deficit result in reduced energy expenditure, an additional down-regulation in expenditure has been noted that cannot be explained by changes in body tissue (e.g. adaptive thermogenesis). Sustained negative energy balance is also associated with an increase in orexigenic drive and changes in appetite-related peptides during weight loss that may act as cues for increased hunger and food intake. It has also been suggested that losses of fat-free mass (FFM) could also act as an orexigenic signal during weight loss, but more data are needed to support these findings and the signalling pathways linking FFM and energy intake remain unclear. Taken together, these metabolic and behavioural responses to weight loss point to a highly complex and dynamic energy balance system in which perturbations to individual components can cause co-ordinated and inter-related compensatory responses elsewhere. The strength of these compensatory responses is individually subtle, and early identification of this variability may help identify individuals that respond well or poorly to an intervention.

scholarly journals ENERGY BALANCE AND VITAL SIGNS IN PEDIATRIC PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Julie A. Young ◽  
Jessica Napolitano ◽  
Mitchell J. Rauh ◽  
Jeanne Nichols ◽  
Anastasia N. Fischer
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Energy Balance ◽  
Energy Expenditure ◽  
Vital Signs ◽  
Negative Energy ◽  
Negative Energy Balance ◽  
Energy Deficit ◽  
Energy Deficiency ◽  
Males And Females

BACKGROUND: Prior studies have shown that vital signs such as heart rate, blood pressure and body temperature are depressed in patients with an eating disorder who have experienced a negative energy balance for a significant amount of time. More recently, a negative energy balance has been the focus of Relative Energy Deficiency in Sport (RED-S), which links energy availability to the health of multiple body systems in adults in as little as 5 days with a negative energy balance. High rates of disordered eating patterns have been reported in high school athletes. As adolescents grow, the consequences of a negative energy balance can be significant and potentially irreversible. Thus, vital signs may help clinicians quickly evaluate a patient’s energy status or highlight them for further evaluation. PURPOSE: The purpose of this study was to examine energy balance and vital signs in a cohort of adolescents who were seen by a sports dietitian to gain weight or optimize sports performance. METHODS: We evaluated 240 subjects, 83% female, average age 15.0±2.3 years. Heart rate and blood pressure were measured with a dynamometer in a seated position. Body temperature was measured orally. Height and weight were recorded. BMI was then calculated and evaluated by percentile. Energy intake was assessed using a 3-day food recall log. Energy expenditure was calculated using Harris Benedict Equation and combined with estimated exercise energy expenditure. Energy balance was estimated as energy intake minus energy expenditure. RESULTS: Average age was 15.03±2.71. 85% were female. 30% were below the 15th percentile for BMI. There were no differences in BMI percentiles between males and females (p=0.99). The average heart rate was 71.62±13.4 bpm and 19% were below the 10th percentile for heart rate. Average systolic blood pressure was 110±11 mm Hg and average diastolic blood pressure was 62±7 mmHg. Average temperature was 98.1±.4 degrees F. 88%were in a negative energy balance with an average energy deficit of 552±511 calories. There were no statistically significant differences in energy balance between males and females (p=0.08). CONCLUSIONS: A disproportional number of children with low BMI and heart rate percentiles was observed, which may indicate a long-standing energy deficiency. We also found a high proportion of adolescents who experienced a standalone negative energy balance itself or vital signs consistent with a negative energy balance. Additional studies are needed to study the relationships between energy deficit magnitude and duration in adolescents and children.

Energy balance and body composition during US Army special forces training

2013 ◽  
Vol 38 (4) ◽  
pp. 396-400 ◽  
Author(s):  
Lee M. Margolis ◽  
Jennifer Rood ◽  
Catherine Champagne ◽  
Andrew J. Young ◽  
John W. Castellani
Keyword(s):  
Body Composition ◽  
Energy Balance ◽  
Body Mass ◽  
Skinfold Thickness ◽  
High Energy ◽  
Negative Energy ◽  
Fat Free Mass ◽  
Energy Deficit ◽  
Special Forces ◽  
Small Unit

Small Unit Tactics (SUT) is a 64-day phase of the Special Forces Qualification Course designed to simulate real-world combat operations. Assessing the metabolic and physiological responses of such intense training allows greater insights into nutritional requirements of soldiers during combat. The purpose of this study was to examine energy balance around specific training events, as well as changes in body mass and composition. Data were collected from 4 groups of soldiers (n = 36) across 10-day periods. Participants were 28 ± 5 years old, 177 ± 6 cm tall, and weighed 83 ± 7 kg. Doubly labeled water (D218O) was used to assess energy expenditure. Energy intake was calculated by subtracting energy in uneaten foods from known energy in distributed foods in individually packaged combat rations or in the dining facility. Body composition was estimated from skinfold thickness measurements on days 0 and 64 of the course. Simulated urban combat elicited that largest energy deficit (11.3 ± 2.3 MJ·day−1 (2700 ± 550 kcal·day−1); p < 0.05), and reduction in body mass (3.3 ± 1.9 kg; p < 0.05), during SUT, while energy balance was maintained during weapons familiarization training and platoon size raids. Over the entire course body mass decreased by 4.2 ± 3.7 kg (p < 0.01), with fat mass decreasing by 2.8 ± 2.0 kg (p < 0.01) and fat-free mass decreasing by 1.4 ± 2.8 kg (p < 0.05). The overall reduction in body mass suggests that soldiers were in a negative energy balance during SUT, with high energy deficit being observed during strenuous field training.

Relationships between energy balance and health traits of dairy cattle in early lactation

1999 ◽  
Vol 24 ◽  
pp. 171-175 ◽  
Author(s):  
B. L. Collard ◽  
P. J. Boettcher ◽  
J. C. M. Dekkers ◽  
L. R. Schaeffer ◽  
D. Petitclerc
Keyword(s):  
Energy Balance ◽  
Food Intake ◽  
Total Energy ◽  
Milk Production ◽  
Additive Genetic Variance ◽  
Negative Energy ◽  
Negative Energy Balance ◽  
Energy Deficit ◽  
Research Station ◽  
Daily Energy

AbstractData were records of daily food intake and milk production, periodic measures of milk composition and all health and reproductive information from 140 multiparous Holstein cows involved in various experiments at the Agriculture Canada dairy research station in Lennoxville, Quebec. Energy concentrations of the total mixed rations were also available. Daily energy balance was calculated by multiplying the food intake by the concentration of energy in the diet and then subtracting from this quantity the expected (National Research Council) amount of energy required for maintenance (based on parity and body weight) and for milk production (based on yield and concentrations of fat, protein and lactose). Four energy balance traits were defined: (1) average daily energy balance within the first 10 to 100 days of lactation, (2) minimum daily energy balance, (3) days in negative energy balance and (4) total energy deficit during the period of negative energy balance. Health traits were the numbers of incidences of each of the following: (1) all udder problems, (2) mastitis, (3) all locomotive problems, (4) laminitis, (5) digestive problems and (6) reproductive problems. Reproductive traits were the number of days to first observed oestrous and number of inseminations. Phenotypic relationships between energy balance and health were investigated by regressing the energy balance traits on each health trait. Parity and treatment (according to the research trial that the cow was involved with) were also included in the model. Genetic parameters were estimated with restricted maximum likelihood and a model that included effects of parity, treatment and animal. Phenotypically, several significant (P<0.10) relationships between energy balance and health were observed. Cows with longer periods of negative energy balance had increased digestive problems. Cows with greater total energy deficit had more digestive problems and laminitis. Estimates of heritabilities for energy intake and milk energy were 0.42 and 0.12, respectively but estimates of heritability for all energy balance traits were zero. The low estimates for these traits may have been due to (1) low true additive genetic variance, (2) small amount of data, or (3) relatively few genetic ties among cows.

scholarly journals The pulmonary cachexia syndrome: aspects of energy balance

1999 ◽  
Vol 58 (2) ◽  
pp. 321-328 ◽  
Author(s):  
Jo Congleton
Keyword(s):  
Energy Balance ◽  
Current Knowledge ◽  
Resting Energy Expenditure ◽  
Prognostic Indicator ◽  
Negative Energy ◽  
Nutritional Supplementation ◽  
Fat Free Mass ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cachexia Syndrome

The present paper reviews current knowledge of the pulmonary cachexia syndrome with reference to chronic obstructive pulmonary disease (COPD). Aspects of incidence, aetiology and management are discussed. Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD. Both fat mass and fat-free mass become depleted. Loss of fat-free mass is the more important and appears to be due to a depression of protein synthesis. Weight loss is an independent prognostic indicator of mortality, and is associated with increased morbidity and decreased health-related quality of life. The aetiology of malnutrition in COPD is not well understood. Reduced food intake does not seem to be the primary cause. Resting energy expenditure (REE) is elevated in a proportion of patients and probably contributes to negative energy balance. Measurement of actual REE is helpful when considering the adequacy of nutritional supplementation. The underlying reason for a hypermetabolic state is not known. Although weight-losing COPD patients are not catabolic, nutritional supplementation alone does not appear to reverse the loss of fat-free mass. Strategies involving nutritional supplementation in combination with a second intervention are being explored, and there are some encouraging results using anabolic hormones.

scholarly journals Energy expenditure and dietary intake of female collegiate tennis and soccer players during a competitive season

Kinesiology ◽  
2019 ◽  
Vol 51 (1) ◽  
pp. 70-77
Author(s):  
Sami Yli-Piipari
Keyword(s):  
Energy Balance ◽  
Energy Expenditure ◽  
Dietary Intake ◽  
Student Athletes ◽  
Dietary Behavior ◽  
Negative Energy ◽  
Soccer Players ◽  
Energy Deficit ◽  
Competitive Season ◽  
Main Effect

This study examined energy expenditure, dietary behavior, and energy balance of female tennis and soccer student-athletes during a competitive season. A sample of 18 (Mage=19.86±1.35 years) Division I female collegiate student-athletes (5 tennis and 13 soccer players) were followed for four days, i. e., during one game/match, two practice sessions, and one recovery day. Physical activity was assessed with accelerometers and dietary behavior with daily food logs. Daily energy expenditure for the game/match, practice, and rest days was 2,848±304kcal, 2,622±248kcal, and 1,833±959kcal, respectively, with a statistically significant main effect (F[2,16]=82.291, p&lt;.001, η2=.91). Daily dietary intake ranged from 1,833±959 to 1849±371kcal, with no significant interaction between different days. There were no sport specific differences in energy expenditure or dietary behaviors. Athletes consumed 4.30±2.07 g/kg carbohydrates, 1.57±.98 g/kg protein, and 1.27±.80 g/kg fats daily. There was a significant main effect in dietary intake (F[2,16]=7.311, p=.006, η2=.48), with a difference between game/match and recovery days (t[17]=3.83, p=.001, d=1.19). This study showed a negative energy balance among female student-athletes. The findings indicate that the lack of carbohydrate intake during game/match days contributed to this energy deficit.

scholarly journals Negative energy balance alters global gene expression and immune responses in the uterus of postpartum dairy cows

2009 ◽  
Vol 39 (1) ◽  
pp. 1-13 ◽  
Author(s):  
D. Claire Wathes ◽  
Zhangrui Cheng ◽  
Waliul Chowdhury ◽  
Mark A. Fenwick ◽  
Richard Fitzpatrick ◽  
...  
Keyword(s):  
Energy Balance ◽  
Inflammatory Response ◽  
Dairy Cows ◽  
Global Gene Expression ◽  
Negative Energy ◽  
Negative Energy Balance ◽  
Energy Deficit ◽  
Nonesterified Fatty Acid ◽  
Canonical Pathways ◽  
Time Required

Most dairy cows suffer uterine microbial contamination postpartum. Persistent endometritis often develops, associated with reduced fertility. We used a model of differential feeding and milking regimes to produce cows in differing negative energy balance status in early lactation (mild or severe, MNEB or SNEB). Blood hematology was assessed preslaughter at 2 wk postpartum. RNA expression in endometrial samples was compared using bovine Affymetrix arrays. Data were mapped using Ingenuity Pathway Analysis. Circulating concentrations of IGF-I remained lower in the SNEB group, whereas blood nonesterified fatty acid and β-hydroxybutyrate concentrations were raised. White blood cell count and lymphocyte number were reduced in SNEB cows. Array analysis of endometrial samples identified 274 differentially expressed probes representing 197 recognized genes between the energy balance groups. The main canonical pathways affected related to immunological and inflammatory disease and connective tissue disorders. Inflammatory response genes with major upregulation in SNEB cows included matrix metalloproteinases, chemokines, cytokines, and calgranulins. Expression of several interferon-inducible genes including ISG20, IFIH1, MX1, and MX2 were also significantly increased in the SNEB cows. These results provide evidence that cows in SNEB were still undergoing an active uterine inflammatory response 2 wk postpartum, whereas MNEB cows had more fully recovered from their energy deficit, with their endometrium reaching a more advanced stage of repair. SNEB may therefore prevent cows from mounting an effective immune response to the microbial challenge experienced after calving, prolonging the time required for uterine recovery and compromising subsequent fertility.

scholarly journals Decreased concentration of plasma leptin in periparturient dairy cows is caused by negative energy balance

2001 ◽  
Vol 171 (2) ◽  
pp. 339-348 ◽  
Author(s):  
SS Block ◽  
WR Butler ◽  
RA Ehrhardt ◽  
AW Bell ◽  
ME Van Amburgh ◽  
...  
Keyword(s):  
Plasma Concentration ◽  
Energy Balance ◽  
Dairy Cows ◽  
Plasma Concentrations ◽  
Negative Energy ◽  
Negative Energy Balance ◽  
Energy Deficit ◽  
Gradual Improvement ◽  
Maternal Metabolism ◽  
Plasma Leptin

Dairy cows suffer from an intense energy deficit at parturition due to the onset of copious milk synthesis and depressed appetite. Despite this deficit, maternal metabolism is almost completely devoted to the support of mammary metabolism. Evidence from rodents suggests that, during periods of nutritional insufficiency, a reduction in plasma leptin serves to co-ordinate energy metabolism. As an initial step to determine if leptin plays this role in periparturient dairy cows, changes in the plasma concentration of leptin were measured during the period from 35 days before to 56 days after parturition. The plasma concentration of leptin was reduced by approximately 50% after parturition and remained depressed during lactation despite a gradual improvement in energy balance; corresponding changes occurred in the abundance of leptin mRNA in white adipose tissue. To determine whether negative energy balance caused this reduction in circulating leptin, cows were either milked or not milked after parturition. Absence of milk removal eliminated the energy deficit of early lactation, and doubled the plasma concentration of leptin. The plasma concentration of leptin was positively correlated with plasma concentrations of insulin and glucose, and negatively correlated with plasma concentrations of growth hormone and non-esterified fatty acids. In conclusion, the energy deficit of periparturient cows causes a sustained reduction in plasma leptin. This reduction could benefit early lactating dairy cows by promoting a faster increase in feed intake and by diverting energy from non-vital functions such as reproduction.

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